Department of Neurology, Mayo Clinic Arizona, Scottsdale, AZ, USA.
Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Headache. 2020 Sep;60(8):1558-1568. doi: 10.1111/head.13903. Epub 2020 Jul 10.
To summarize the current literature on non-steroidal anti-inflammatory drug and corticosteroid use during the coronavirus disease 2019 (COVID-19) pandemic, recognizing that these are commonly used treatments in the field of headache medicine.
The use of non-steroidal anti-inflammatory drugs and corticosteroids in patients during the COVID-19 pandemic has been a controversial topic within the medical community and international and national health organizations. Lay press and social media outlets have circulated opinions on this topic despite the fact that the evidence for or against the use of these medications is sparse. In the field of headache medicine, these medications are used commonly and both patients and clinicians may have questions or hesitations pertaining to their use during the COVID-19 pandemic.
A detailed search of the scientific and popular literature was performed.
There is limited literature pertaining to the safety of non-steroidal anti-inflammatory drugs and corticosteroids during the COVID-19 pandemic. To date, there are no clear scientific data that preclude the use of non-steroidal anti-inflammatory drugs in the general population who may acquire COVID-19 or in those acutely infected with the virus. Several health organizations have concluded that treatment with corticosteroids during active infection should be avoided due to concerns of prolonged viral shedding in the respiratory tract and the lack of survival benefit based on the data from past coronaviruses and influenza virus; specific exceptions exist including treatment for underlying asthma or chronic obstructive pulmonary disease, septic shock, and acute respiratory distress syndrome.
Scientific information regarding the COVID-19 pandemic is constantly evolving, and limited or contradictory information can lead to confusion for both patients and clinicians. It is recommended that prior to prescribing non-steroidal anti-inflammatory drugs and steroids for the treatment of headache, clinicians have open discussions with their patients about the potential risks and benefits of using these medications during the COVID-19 pandemic. This manuscript summarizes the currently available evidence and understanding about these risks and benefits to help clinicians navigate such discussions.
总结当前关于在 2019 年冠状病毒病（COVID-19）大流行期间使用非甾体抗炎药和皮质类固醇的文献，认识到这些药物是头痛药物领域常用的治疗方法。
在 COVID-19 大流行期间，在患者中使用非甾体抗炎药和皮质类固醇一直是医学界以及国际和国家卫生组织内部的一个有争议的话题。尽管关于使用这些药物的证据很少，但大众媒体和社交媒体上仍然流传着对该话题的看法。在头痛药物领域，这些药物的使用很常见，患者和临床医生可能会对在 COVID-19 大流行期间使用这些药物产生疑问或疑虑。
对科学文献和大众文献进行了详细搜索。
目前关于 COVID-19 大流行期间非甾体抗炎药和皮质类固醇安全性的文献有限。迄今为止，没有明确的科学数据表明在可能感染 COVID-19 的普通人群中或在急性感染病毒的人群中不能使用非甾体抗炎药。一些卫生组织得出结论，由于担心呼吸道病毒持续排出以及根据过去的冠状病毒和流感病毒的数据没有生存获益，应避免在活动性感染期间使用皮质类固醇治疗；具体的例外情况包括治疗潜在的哮喘或慢性阻塞性肺疾病、脓毒症休克和急性呼吸窘迫综合征。
关于 COVID-19 大流行的科学信息不断发展，有限或相互矛盾的信息可能会使患者和临床医生感到困惑。建议临床医生在开处方用非甾体抗炎药和类固醇治疗头痛之前，与患者就使用这些药物在 COVID-19 大流行期间的潜在风险和获益进行公开讨论。本文总结了有关这些风险和获益的现有证据和认识，以帮助临床医生进行此类讨论。
